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Chlera
Chlera
Chlera
Cholera
Dr.Abdulla Muharram
Importance:
• The number of cholera patients worldwide is
uncertain because many cases are unreported,
Dr.Abdulla Muharram
Global cholera situation
In 2018, 18 countries reported a total of 132 121
confirmed cholera cases.
Haiti, Congo, Yemen , Somalia, and Tanzania
accounted for 80% of all cases.
Dr.Abdulla Muharram
Importance – cont.
Dr.Abdulla Muharram
Cholera situation in Yemen
2 waves: wave 1 (25 839 cases), wave 2 (1 055 504
cases).
Deaths 2255.
Case fatality rate 0.21%.
Governorates affected 96%.
Western part of Yemen was more affected.
Vibrio cholera 01 serotype Ogawa was confirmed
(same strain during two waves).
Dr.Abdulla Muharram
Epidemiology
I. Since 1817, there have been 7 cholera
pandemics.
Dr.Abdulla Muharram
EPIDEMIOLOGY – cont.
Dr.Abdulla Muharram
EPIDEMIOLOGY – cont.
Dr.Abdulla Muharram
Epidemiology - cont.
V. Crowding & gathering of people during
religious rituals (e.g. Muslims pilgrimage to
Mecca or Hindu swimming festivals in holy
rivers) enhance the spread of infection.
Dr.Abdulla Muharram
Reservoir :
Cholera has 2 main reservoirs:
1)Man:
Cases
Carriers.
2)Environmental reservoir.
Dr.Abdulla Muharram
Agent :
Gram-negative bacillus Vibrio cholerae O1 and
Vibrio cholerae O139 .
Vibrio cholerae produces a powerful enterotoxin.
V. cholerae has 2 major biotypes: classical and El
Tor.
Dr.Abdulla Muharram
Susceptibility :
Patients with chronic gastritis secondary to
Helicobacter pylori infection or those who have
had a gastrectomy.
Period of communicability:
Presumably for the duration of the stool-positive
stage, usually only a few days after recovery.
Occasionally the carrier state may persist for
several months. Effective antibiotics, e.g.
tetracycline, shorten the period of
communicability.
Dr.Abdulla Muharram
Prevention and control
Being Prepared: Long –Term Activities
Training in clinical management of acute
diarrhea,
Health education;
Environmental sanitation;
Disposing human waste,
Assuring a safe water supply,
Food safety.
Detecting a cholera out breaks: Surveillance and
case reporting;
Dr.Abdulla Muharram
Prevention and control - cont
Early Responses to the threat of an outbreaks
1) National coordinating committee;
Regional and international collaboration,
Collecting and reporting of information,
Organization of any necessary training,
Procurement, storage, and distribution of required
supplies,
Implementation, monitoring, and evaluation of control
activities.
2)Establishing mobile control teams;
3)Supplies and equipment.
Dr.Abdulla Muharram
TREATMENT
The primary goal of therapy is to replenish fluid
losses caused by diarrhea & vomiting.
Dr.Abdulla Muharram
Fluid Therapy :
Ringer lactate solution is preferred over normal
saline because it corrects the associated metabolic
acidosis.
Dr.Abdulla Muharram
Drug therapy :
o The goals of drug therapy are to eradicate
infection, reduce morbidity and prevent
complications.
Dr.Abdulla Muharram
Drug therapy – cont.
o Drug therapy reduces volume of stool & shortens
period of hospitalization. It is only needed for few
days (3-5 days).
Dr.Abdulla Muharram
Preventing the spread of the outbreaks:
Health education,
Dr.Abdulla Muharram
Preventing the spread of the outbreaks – cont.
Dr.Abdulla Muharram
Vaccination – cont.
Doses:
ShancholTM at least 2 doses – 2-4 weeks apart.
DukoralR at least 2 doses – 2-4 weeks apart.
Conferred protection:
Up to 85% for first 6 months.
50-62% in the first year.
˂50% after 2 years.
˂40% for 6 months if used as single dose.
Revaccination is recommended in endemic areas.
Dr.Abdulla Muharram
Vaccination – cont.
Regarding to WHO Position august 2017:
Vaccines should be used in areas with endemic
cholera, humanitarian crises with high risk of
cholera, and during cholera outbreaks.
The vaccines should always be used in conjunction
with other cholera prevention and control strategies.
Vaccination should not disrupt the provision of other
high priority health interventions to prevent and
control cholera outbreaks.
Dr.Abdulla Muharram